Numbers and Neuropathy

Theresa answers more questions from the dLife community

In this month's column, readers wrote in about blood glucose numbers and neuropathy. Here is what some of you had on your mind.

Q. How do high and low blood glucose levels affect athletes' stomachs? My 8-year-old son is constantly complaining of a stomachache. We are seeing a specialist and he wants to do a biopsy, but I have been putting it off. I know diabetics can have problems with their digestive systems when their A1C's are too high.

A. Stomach pain in an active type 1 can occasionally occur due to ketones building up in the bloodstream during periods of hyperglycemia. This can be a sign of diabetic ketoacidosis, a very dangerous condition that we all try to prevent. What is your son's A1C level? Is it ideal (which could also mean he has periods of highs that are balanced by periods of lows)? Has he had a continuous glucose monitoring device to study glucose patterns during exercise? If you are not comfortable with the specialist's suggestion, perhaps consider getting a second opinion.

Q: I was recently diagnosed with diabetes last June. I was in shock and depressed for several weeks. Now I am doing better. My first A1c came in at 7.1% and my last one was 5.9%. My doctor says I can still reverse the diabetes. What number do I need to reverse it? I watched a recent dLife show about neuropathy, and how it can affect the internal organs. Lately, I have been feeling tingling all over my body, but my sugar has been at 98-110. Is that neuropathy?

A. Congratulations on your well-controlled diabetes! The question you posed about reversing diabetes is asked frequently. Unfortunately, once you have diabetes, you'll always have it. Luckily, unlike other terminal types of medical problems, there is a lot you can do to control diabetes, just like you have demonstrated. Your A1C value of 5.9% means you have followed a pattern of healthy eating, regular activity and/or taken medications. Should you eat something sweet, like one of the cake wedges displayed in a local bakery store window, your glucose level will go up, most likely above 140 (the upper diagnostic limit when you have had something to eat). The Diabetes Prevention Program showed that people whose glucose values were in the prediabetes range (a fasting between 101-125, or a random/anytime of the day reading between 141-199) could prevent their glucoses from going into the official diabetes range (2 fasting values more than 125, or a onetime reading of more than 200 with symptoms of diabetes). There is a big difference between preventing and reversing diabetes. You can reverse complications, as evidenced by the Diabetes Control and Complication Trial. In essence, on paper, it might look like you don't have diabetes. In actuality, it means your diabetes is under tight control, something that others work months and years to attain.

Neuropathy can be caused from glucose values that have been high for a number of years. One recent study showed the average person has diabetes 7 years before getting diagnosed. If that was the case, it is possible to have symptoms of neuropathy in spite of a recent, saintly-looking A1C. Since the symptoms you described seem to have started recently, I would recommend discussing it with your doctor. Tingling all over the body, is not a typical sign of diabetic neuropathy (everyone is different, so we need to be cautious about generalizing); it can be a sign of hyperventilation which can sometimes occur when people breathe too quickly under periods of stress or anxiety. Tingling can also occur from a pinched spinal nerve, and rarely, when someone is anemic or has poor circulation. Best bet is to have it checked out.

by
Brenda Bell
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...